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BURN

By:
AILEEN C. CONTRERAS-LIMJOCO M.D.

Burns
are a type of traumatic injury caused by

thermal, chemical, electrical, sunlight or


radiation, and electromagnetic energy.
Most common causes:
Scalds from hot liquids and steam leading
cause of burn injury in children
Open flames leading cause of burn injury for
adults
ex: Building fires and flammable liquids and
gases

Essentials of Diagnosis:
Estimates of the burn location, size and depth

greatly determine treatment plan.


The first 48 hours after the burn injury offer the
greatest opportunity to impact the survival of
the patient.
Early surgical intervention, wound care, enteral
feeding, glucose control and metabolic
management,infection control, and prevention of
hypothermia and compartment syndrome have
contributed to significantly lower mortality rates
and shorter hospitalizations

TYPES OF BURNS

Types of Burns
THERMAL BURNS
burns due to external heat sources which raise the temperature of the skin

and tissues and cause tissue cell death or charring.


a.) Flash - Explosions of natural gas, propane, gasoline and other flammable
liquids. Intense heat for a very brief period of time. Clothing is protective
unless it ignites
b.) Flame - Exposure to prolonged, intense heat. House fires, improper use of
flammable liquids, automobile accidents, ignited clothing from stoves/heaters.
c.) Scalds - Burns caused by hot liquids. Water, oil, grease, tar, oil. Water at
140 degrees F, creates a deep burn in 3 seconds, but at 156 degrees F will
cause the same injury in 1 second. (Coffee is 180 degrees F just brewed).
Circumferential burns should raise suspicion of non-accidental trauma. Tar
needs to be removed either with an adhesive remover solution or petroleum
based dressings.
d.) Contact - Result from hot metals, plastics, glass or coals. Can be very
deep.

RADIOLOGICAL

- Caused by alpha, beta or gamma radiation.


They may need to have some type of
decontamination done to stop the injury.

CHEMICAL
Caused by strong acids or alkali substances. They

continue to cause damage until the agent is


inactivated. Alkali substances usually cause more
severe injury since they react with the lipids in the skin.
ELECTRICAL
- Caused by either AC or DC current. Current follows the
path of least resistance and causes injury in areas
other than the contact/entry site. They cannot be
judged from the external injury alone. High voltage >
1,000 volts, low voltage < 1,000 volts and lightening.
Electrical burns are thermal burns from very high heat.

Classification of Burns

Classification of Burns
Determining burn depth is important.
Things to consider are temperature,

mechanism, duration of contact, blood flow to


skin, and anatomic location. Epidermal depth
varies with body surface, which can offer
varying degrees of thermal protection. Older
adults and young children also have thinner
skin

First degree
Includes only the outer layer of skin, the
epidermis
Skin is usually red and very painful
Equivalent to superficial sunburn without
blisters
Dry in appearance
Healing occurs in 3-5 days, injured epithelium
peels away from the healthy skin
Hospitalization is for pain control and maybe
fluid imbalance

Classification of Burns
Normal skin

First degree Burn

Sunburn

Second degree
Can be classified as partial or full thickness.

Superficial Partial thickness


Blisters can be present
Involve the entire epidermis and upper layers of

the dermis
Wound will be pink, red in color, painful and wet
appearing
Wound will blanch when pressure is applied
Should heal in several weeks (10-21 days)
without grafting, scarring is usually minimal

Classification of Burns
Normal skin

Second degree burn


Superficial Partial Thickness

Scald Injury

Scald Injury to the foot


Superficial Partial thickness

Second degree
Deep Partial thickness
Can be red or white in appearance, but will

appear dry.
Involves the destruction of the entire epidermis
and most of the dermis
Sensation can be present, but diminished
Blanching is sluggish or absent
Deep partial thickness will most likely need
excision & skin grafting to heal
These burns do not heal in less than three
weeks and often result in scarring and
contractures

Classification of Burns
Normal Skin

Second degree burn


Deep Thickness

Deep partial-thickness burn to the


abdomen and arm of a child

Third Degree
All layers of the skin is destroyed
Extend into the subcutaneous tissues
Areas can appear, black or white and will be

dry
Can appear leathery in texture
Will not blanch when pressure is applied
No pain
Can result to contractures

Classification of Burns
Normal Skin

Third degree Burn

Third-degree burns extend into the fat layer


that lies beneath the dermis. The skin may
appear stiff, waxy white, leathery or tan.

Fourth degree
Full thickness that extends into muscle and

bone.
most severe form of burn affects structures
well beyond the skin, such as muscle and
bones.
The skin may appear blackened or charred.
If nerve damage is substantial, you may feel
no pain at all.

Fourth degree

Management OF BURNS

Goal:
Protect the wound from desiccation and avoid

further injury or infection

Assess:
Airway
Breathing: beware of inhalation and rapid

airway
compromise
Circulation: fluid replacement
Disability: compartment syndrome
Exposure: percentage area of burn.

Essential management points:


Stop the burning
ABCDE
Determine the percentage area of burn (Rule

of 9s)
Good IV access and early fluid replacement.

The severity of the burn is determined by:


Burned surface area
Depth of burn
Other considerations.
Morbidity and mortality rises with increasing

burned surface area.


It also rises with increasing age so that even
small
burns may be fatal in elderly people.

Rule of 9s

The Rule of 9s method is too imprecise for

estimating the burned surface area in


children because the infant or young childs
head and lower extremities represent different
proportions of surface area than in an adult
Burns greater than 15% in an adult, greater
than 10% in a child, or any burn occurring in
the very young or elderly are serious.

Depth of Burn

Layers Involved

Characteristics

First Degree

Epidermis

Red without
blisters
Dry, Painful

Second Degree
Superficial
Partial Thickness

Extends into
superficial dermis

Redness with clear


blister. Blanches
with pressure
Moist, Very Painful

Second Degree
Deep Partial
Thickness

Extends into deep


dermis

Yellow or white.
Less blanching.
May be blistering.
Fairly dry,
Pressure and
Discomfort

Third Degree
Full Thickness

Extends through
entire dermis

Stiff and
white/brown No
blanching,
Leathery,Painless

Fourth Degree

Extends through
entire skin, and
into underlying fat,

Black; charred with


eschar,dry,painless

Depth of Burn

Healing Time

Prognosis

First Degree

5-10 days
(reepitheliazation)

Heals well, although


repeated sunburns
inc. the risk of skin
cancer

Second degree
Superficial Partial
Thickness

Less than 2-3 weeks

Local infection/
cellulitis may occur
but no scarring

Second Degree
Deep Partial
Thickness

3-8 weeks

Scarring,
Contractures may
occur (may require
excision and skin
grafting)

Third Degree

Prolonged(months)
and Incomplete

Scarring,
contractures,
amputation (early
excision
recommended

Fourth Degree

Amputation,
significant functional
impairment and, in
some cases, death

Management:
1.) CHEMOPROPHYLAXIS
A.) Tetanus Immunization
B.) Antibiotics
2.) SURGICAL MANAGEMENT
A.) Debridement, dressings, and topical and
systemic
antibiotic therapy

Minor burns debride at bedside to assess


the severity and depth
Should be thoroughly cleansed

Thereafter, the woundshould be debrided

daily and dressed with a topical antibiotic and


a wound dressing.
Patient compliance and adequate pain
treatment is essential for successful
outpatient treatment.
The wound should be reevaluated within 24
72 hours to evaluate for signs of infection.

For Severely burned patients:


early excision and grafting of burned areas may

be performed as soon as 24 hours after burn


injury or when the patient can hemodynamically
tolerate the excision and grafting procedure.
Meticulous prevention of infections, seromas,
hypergranulation tissue formation, and
malnutrition all decrease the time to complete
wound healing in skin-grafted patients.
Skin autograft is the most definitive treatment.

Management
First Degree
1. Prompt cold applications (ice water or cold

tap water), continued until pain does not


return -Immediate first aid for minor burns
2. Clean wound with sterile water
3. NSAIDS for pain
4. Lotions, Honey, Aloe vera, Antibiotic
ointments

Management
Second degree
1. Vesicles or blebs should not be opened or
2.

3.
4.
5.

punctured - contamination of microorganisms


Vesicles if becomes tense and unduly painful,
fluid may be evacuated under aseptic conditions.
(puncturing with a sterile needle allowing the
blister to collapse on to the underlysing wound
Administer tetanus prophylaxis
NSAIDS for pain
Antibiotic creams

Management
Third degree and Fourth degree
Admit patients and administer intravenous fluid to

improve perfusion (Fluid Resuscitation)


Treatment of Inhalation Injury
Excision of full thickness and deep dermal wounds
- reduces wound infections
- shortens hospital stays
-improves survival
-lessen contractures and functional impairment
Intravenous and Topical Antibiotics

BURN PREVENTION

In the Kitchen
Keep pot handles turned away from the edges of the stove &

consider using the back burners


Coil appliance cords away from the edge of the counter to
prevent your child from pulling hot food down on themselves
Create a safe zone in the kitchen while cooking
Do not eat or drink hot food while holding small children on
your lap
Do not use tablecloths around small children to prevent them
from pulling hot food onto themselves
Never let children remove food or drinks from the microwave
Keep a fire extinguisher available and in working order
Contain grease fires with baking soda or flour not water

In the bathroom
Stir bath water with your hand to avoid hot

spots. If the water is hot for your hand, it is


too hot for your child
Stay with your child at all times, it only takes
a second for a child to turn on the hot water

Around the house


Matches & lighters should be kept in a high, locked

cabinet. Teach your child that these objects are not


toys
Discuss fire hazards with your child
Test smoke detectors monthly, change batteries
every 6 months.
Develop an evacuation plan, practice with your
children. Establish a safe meeting place outside
the home
Do not leave candles unattended

Flammable Liquids
Do not clean with gasoline
Do not use gasoline or other flammable liquids to start

fires, woodstoves or barbeques


Gasoline or other flammable liquids should never be
poured into a vehicle engine or carburetor
Store gasoline & other flammable liquids out of the reach
of children
Transport gasoline & other flammable liquids in approved
containers. Never store gas in the house or garage
Never siphon gasoline by mouth. It can be fatal if
swallowed.

Thank you